practicing supination and pronation of the arm

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last update: 30.10.2023
Level: A

Classification

Functional exercise

Contraindication

In the case of a golfer’s elbow, a special procedure described below applies to the execution of pronation; the same applies to supination in the case of a tennis elbow.

Diagnostics

Pain occurring on the medial epicondyle of the humerus during pronation of the arm clearly indicates a golfer’s elbow of the forearm-pronator golfer’s elbow type, in which the insertion of the pronator teres is affected. Localized tenderness at the epicondyle and in the area of the immediately distally connected tendons confirms the suspicion. If there is tenderness at the lateral epicondyle and pain in supination, a tennis elbow is suspected, in which the origin of the supinator muscle is affected. Note that mixed types of golfer’s elbow and tennis elbow are not uncommon. It is also possible for both disorders to occur simultaneously.

Instructions

Sit on the floor and place your forearm horizontally in front of you on a suitable elevation such as a weight bench, two or three flat stacked blocks or an appropriate number of shoulder support plates so that the forearm can rotate freely. If no aid is available, this can also be your own thigh in a seated position.
Depending on the desired load, grip an unloaded dumbbell bar a little to far from the center so that the longer end is on the side of the thumb.
When fully comfortable, rotate your forearm back and forth on the support with your hand and wrist extended. If the exercise is too easy, grip the barbell so that the longer section is a little longer.

Details

This exercise can be used to practise pronation (right half of the image) and supination (left half of the image) at the same time: if the palm of the hand is facing upwards, pronation is practised; the pronator teres muscle, which originates from the medial ep icondyle of the humerus, then applies the required torque together with the pronator quadratus muscle, which does not originate there. If, on the other hand, the palm of the hand is facing downwards, supination is practiced and the supinator muscle, which arises from the lateral epicondyle of the humerus, provides the necessary torque on its own. If one movement proves to be significantly more difficult than the other, this indicates a weakness that should be worked on. The effectiveness of the exercise increases on each side up to the horizontal of the bar, as this is where the maximum gravitational effect is achieved.
To increase the effectiveness, the barbell can be gripped further and further towards one end. If this is not enough, the longer end can be fitted with a suitable weight plate.
If the olecranon is pointing exactly downwards, the palm is usually turned further upwards in the fully supinated position than it is pointing downwards in the fully pronated position. The center of the ROM is therefore present with the olecranon pointing slightly laterally. The upper arm can be tilted accordingly (to a limited extent) to adjust the working range.
This exercise is suitable for general strengthening, but also for rehabilitative training for golfer’s elbow if the pronator teres muscle is affected or for tennis elbow if the supinator muscle is affected. However, in the case of these pain phenomena, the strain must be measured in such a way that the typical pain is not triggered. Since it is known that in most insertional tendinopathies the triggering of pain depends on load and sarcomere length, these parameters can be experimented with. Perform the movement with light to maximum tolerated weight so that the pain is regularly not triggered. If the maximum weight is used that can still be moved pain-free over the entire ROM, the weight can be increased slightly as an experiment, but then without fully utilizing the ROM, which must also be possible without triggering pain. In the case of a golfer’s elbow or tennis elbow, it should be checked which muscles suffer frominsertional tend inosis(insertional tendinopathy of the muscle origin). These movements must then be handled with great care in everyday life and sport and any triggering of pain must be avoided. It is not uncommon for more than one muscle and one movement to be affected. For more details, see the pathology section for these disorders.
In addition to the rule of generally avoiding pain completely, rehabilitative training can be used to test whether pain triggered at a long sarcomere length in the order of NRS 6 – 8 decreases with an isometric holding time of up to 30 seconds. This can then be practiced up to about three times a day, but the majority of rehabilitative training should take place with at best moderate pain intensity of approx. NRS 2-3.
The degree of acceleration at the start of the movement is a relevant factor. If acceleration is fast, the inertia of the object (and of course, although less relevant due to the lever arm, the arm itself) requires greater use of muscle power, which leads to greater tendon forces and therefore earlier pain triggering. In terms of rehabilitative training, slow movements, especially slow accelerations, are indicated. If there are no significant restrictions in flexibility in the direction of pronation and supination, the full ROM can be dispensed with for rehabilitative purposes so that the tendon can be trained more effectively due to the higher pain-free force possible. After complete healing, it is generally not critical to restore the full range of motion if it has suffered as a result of rehabilitative training.
If you have golfer’s elbow or tennis elbow, you should start with the dumbbell bar held exactly in the middle, as even a slight shift away from the middle can trigger the familiar pain and may therefore help to maintain the disorder

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